Extracorporeal membrane oxygenation provides support for patients with severe acute cardiopulmonary failure, allowing the application of lung or myocardial rest in anticipation of organ recovery, or as a bridge to long-term support. Advances in technology have improved the safety and ease of application of extracorporeal membrane oxygenation. Percutaneous cannulation is one of these advances and is now preferred over surgical cannulation in most cases. Percutaneous cannulation is increasingly performed by intensivists, cardiologists, interventional radiologists, and related specialties. The objective of this study is to review the experience of percutaneous cannulation by intensivists at a single institution.

Streptococcus pneumoniae is a common cause of otitis media (OM) in children; mastoiditis remains an important complication of OM. Limited data are available on the impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal otitis.

The PI-3 kinase-Akt pathway plays a role in cartilage anabolic as well as catabolic processes in response to activation by insulin-like growth factor-1 (IGF-1) and the pro-inflammatory cytokines interleukin-1β (IL-1β) and oncostatin M (OSM). The goal of this study was to determine how PI-3 kinase-Akt signaling regulates these seemingly opposing functions.

A recent study reveals a dynamic neural map that provides a continuous representation of remembered visual stimulus locations with respect to constantly changing gaze. This finding suggests a new mechanistic framework for understanding the spatiotemporal dynamics of goal-directed action.

The self-assembly of octahedral metal clusters (diamagnetic [Nb(6)Cl(12)(CN)(6)](4-) or paramagnetic [Ta(6)Cl(12)(CN)(6)](3-)), [Mn(salen)](+) [salen = N,N'-ethylenebis(salicylidene)iminate] and mononuclear {M'(CN)(x)} polycyanometallates ([Fe(CN)(6)](4-), [Cr(CN)(6)](3-), [Fe(CN)(5)(NO)](2-), or [Ni(CN)(4)](2-)) building blocks results in the formation of a series of six cluster-containing 3D heterotrimetallic frameworks: [H(3)O](2)[Nb(6)Cl(12)(CN)(6)[Mn(salen)](6)Fe(CN)(6)]·3H(2)O (1), [H(3)O][Nb(6)Cl(12)(CN)(6)[Mn(salen)](6)Cr(CN)(6)]·4H(2)O (2), [Nb(6)Cl(12)(CN)(6)[Mn(salen)](6)Fe(CN)(5)(NO)]·5H(2)O (3), [Nb(6)Cl(12)(CN)6[Mn(salen)](6)Ni(CN)4]·7H(2)O (4), [H(3)O][Ta(6)Cl(12)(CN)(6)[Mn(salen)](6)Fe(CN)6]·4H(2)O (5), and [Ta(6)Cl(12)(CN)(6)[Mn(salen)](6)Cr(CN)(6)]·7H(2)O (6). Single-crystal X-ray diffraction analyses show that compounds 1, 2, 5, and 6 have distorted face-centered-cubic frameworks that can be considered as superexpanded Prussian blue analogues built of two different hexacyanometallate nodes and expanded by insertion of the [Mn(salen)](+) complex, while 4 features a quasi-superexpanded Prussian blue framework because the structure is based on the hexacyano metal cluster and disordered tetracyano [Ni(CN)(4)](2-) nodes. The powder X-ray diffraction of 3 indicates that it possesses a quasi-superexpanded Prussian blue framework based on the hexacyano cluster and disordered pentacyano [Fe(CN)(5)(NO)](2-) nodes. Compound 6 is the first compound containing three 3d-3d'-M6 cluster (4d) spin centers. Magnetic measurements reveal that the overall magnetic nature can be systematically controlled by the choice of the octahedral metal cluster and polycyanometallate nodes. H(2)/N(2) adsorption and thermal stability of the compounds were investigated.

The aim of this study was to examine how patterns of academic and behavior problems in the first grade relate to longitudinal transitions in marijuana use from middle school through entry into high school among African-Americans.

Deep tissue injury (DTI) is caused by prolonged mechanical loading that disrupts blood flow and metabolic clearance. A patient simulator that mimics the biomechanical aspects of DTI initiation, stress and strain in deep muscle tissue, would be potentially useful as a training tool for pressure-relief techniques and testing platform for pressure-mitigating products. As a step toward this goal, this study evaluates the ability of silicone materials to mimic the distribution of stress in muscle tissue under concentrated loading.

Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury, with NCCT as the first-line of imaging for patients with traumatic brain injury and MR imaging being recommended in specific settings. Advanced neuroimaging techniques, including MR imaging DTI, blood oxygen level-dependent fMRI, MR spectroscopy, perfusion imaging, PET/SPECT, and magnetoencephalography, are of particular interest in identifying further injury in patients with traumatic brain injury when conventional NCCT and MR imaging findings are normal, as well as for prognostication in patients with persistent symptoms. These advanced neuroimaging techniques are currently under investigation in an attempt to optimize them and substantiate their clinical relevance in individual patients. However, the data currently available confine their use to the research arena for group comparisons, and there remains insufficient evidence at the time of this writing to conclude that these advanced techniques can be used for routine clinical use at the individual patient level. TBI imaging is a rapidly evolving field, and a number of the recommendations presented will be updated in the future to reflect the advances in medical knowledge.

Next-generation sequencing (NGS) machines can sequence millions of DNA strands in a single run, such as oligonucleotide (oligo) libraries comprising millions to trillions of discrete oligo sequences. Capillary electrophoresis is an attractive technique to select tight binding oligos or "aptamers" because it requires minimal sample volumes (e.g., 100 nL) and offers a solution-phase selection environment through which enrichment of target-binding oligos can be determined quantitatively. We describe here experiments using capillary transient isotachophoresis (ctITP)-based nonequilibrium capillary electrophoresis of equilibrium mixtures (NECEEM) as a method for selecting aptamers from a randomized library containing a known (29mer) thrombin-binding aptamer. Our capillary electrophoresis (CE)-selected samples were sequenced by the Ion Torrent Personal Genome Machine (PGM) and analyzed for selection efficiency. We show that a single round of CE selection can enrich a randomer synthetic DNA oligo mixture for thrombin-binding activity from 0.4 % aptamer content before selection to >15 % aptamer content.

Preclinical data suggest that oxytocin reduces hypersensitivity by actions in the spinal cord, but whether it produces antinociception to acute stimuli is unclear. In this article, the authors examined the safety of intrathecal oxytocin and screened its effects on acute noxious stimuli.

We studied incident atrial fibrillation (AF) in the prospective community-based Multi-Ethnic Study of Atherosclerosis (MESA). Reportedly, non-Hispanic blacks (NHBs) have a lower AF burden compared with their non-Hispanic white (NHW) counterparts. Information on the epidemiology of AF in Hispanic and Asian populations is much more limited.

As the second most prevalent hematologic malignancy, multiple myeloma (MM) remains incurable and relapses due to intrinsic or acquired drug resistance. Therefore, new therapeutic strategies that target molecular mechanisms responsible for drug resistance are attractive. Interactions of tumor cells with their surrounding microenvironment impact tumor initiation, progression and metastasis, as well as patient prognosis. This cross-talk is bidirectional. Tumor cells can also attract or activate tumor-associated stromal cells by releasing cytokines to facilitate their growth, invasion and metastasis. The effect of myeloma cells on bone marrow stromal cells (BMSCs) has not been well studied. In our study, we found that higher stiffness of BMSCs was not a unique characteristic of BMSCs from MM patients (M-BMSCs). BMSCs from MGUS (monoclonal gammopathy of undetermined significance) patients were also stiffer than the BMSCs from healthy volunteers (N-BMSCs). The stiffness of M-BMSCs was enhanced when cocultured with myeloma cells. In contrast, no changes were seen in myeloma cell-primed MGUS- and N-BMSCs. Interestingly, our data indicated that CD138⁻ myeloma cells, but not CD138⁺ cells, regulated M-BMSC stiffness. SDF-1 was highly expressed in the CD138⁻ myeloma subpopulation compared with that in CD138⁺ cells. Inhibition of SDF-1 using AMD3100 or knocking-down CXCR4 in M-BMSCs blocked CD138⁻ myeloma cells-induced increase in M-BMSC stiffness, suggesting a crucial role of SDF-1/CXCR4. AKT inhibition attenuated SDF-1-induced increases in M-BMSC stiffness. These findings demonstrate, for the first time, CD138⁻ myeloma cell-directed cross-talk with BMSCs and reveal that CD138⁻ myeloma cells regulate M-BMSC stiffness through SDF-1/CXCR4/AKT signaling.

Donor shortage remains a continued challenge in liver transplantation. Recent advances in tissue engineering have provided the possibility of creating functional liver tissues as an alternative to donor organ transplantation. Small bioengineered liver constructs have been developed, however a major challenge in achieving functional bioengineered liver in vivo is the establishment of a functional vasculature within the scaffolds. Our overall goal is to bioengineer intact livers, suitable for transplantation, using acellular porcine liver scaffolds. We developed an effective method for reestablishing the vascular network within decellularized liver scaffolds by conjugating anti-endothelial cell antibodies to maximize coverage of the vessel walls with endothelial cells. This procedure resulted in uniform endothelial attachment throughout the liver vasculature extending to the capillary bed of the liver scaffold and greatly reduced platelet adhesion upon blood perfusion in vitro. The re-endothelialized livers, when transplanted to recipient pigs, were able to withstand physiological blood flow and maintained for up to 24 h. This study demonstrates, for the first time, that vascularized bioengineered livers, of clinically relevant size, can be transplanted and maintained in vivo, and represents the first step towards generating engineered livers for transplantation to patients with end-stage liver failure.

In The News

On March 20, seniors at Wake Forest School of Medicine learned where they will begin their careers as doctors at Match Day,an annual event at which graduating medical students learn where they’ll be doing their residencies. This year 113 Wake Forest medical students, 59 men and 54 women, matched in 20 specialties.

Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.